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Elevated IOP, glaucoma complications of herpetic anterior uveitis
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A study confirmed that elevated IOP and secondary glaucoma are frequent complications of herpetic anterior uveitis and that the number of IOP peaks is correlated with the risk for glaucoma.
The medical records of 73 patients with herpetic anterior uveitis were analyzed. Elevated IOP was found in 75% of the cases and glaucoma in 15% of the cases. Glaucoma developed during the follow-up for uveitis after an average of 3.9 years.
IOP-lowering medications were administered in 64% of the patients, and 19% required surgery, mainly implantation of a Baerveldt glaucoma drainage device (Johnson & Johnson Vision). Active uveitis was treated with systemic antiviral medications in 90% of the patients and with topical corticosteroids in all cases, with the addition of oral corticosteroids or periocular corticosteroid injections in persistent and severe cases. The number of IOP peaks was significantly higher in the patients who developed glaucoma.
Increased IOP in anterior uveitis is likely due to outflow obstruction as a result of inflammation and swelling of the trabecular meshwork, the authors noted. Another common mechanism is the formation of peripheral anterior synechiae. Corticosteroids, a mainstream treatment for uveitis, may also play a role. However, because elevated IOP was measured at the start of a uveitis episode, the mechanism of obstruction owing to inflammation seems to be the most common cause in this series.
“In addition to frequent IOP measurements and low-threshold treatment of elevated IOP, therapeutic modalities consisting of long-term antiviral treatment to prevent new uveitis episodes and IOP peaks may be beneficial,” the authors suggested. – by Michela Cimberle
Disclosure s : The authors report no relevant financial disclosures.
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